Provider Demographics
NPI:1275283020
Name:HOLLOWAY, DEVYN MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:DEVYN
Middle Name:MICHELLE
Last Name:HOLLOWAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEVYN
Other - Middle Name:MICHELLE
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1458 WORKMORE MILAN RD
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-5190
Mailing Address - Country:US
Mailing Address - Phone:912-500-9843
Mailing Address - Fax:
Practice Address - Street 1:815 LEGION DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6782
Practice Address - Country:US
Practice Address - Phone:478-374-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004413225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant